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A Nationwide Curriculum Analysis of Integrated Plastic Surgery Training: Is it Standardized?
Lisa F. Schneider, Jason Barr, MD, Pierre B. Saadeh, MD.
Institute of Reconstructive Plastic Surgery, New York, NY, USA.
ABSTRACT – Category: Other (Education)
Background: The integrated model of plastic surgery education will shortly become the standard for all six-year programs. Unlike the coordinated model, the integrated program requirements set minimal (36 months) but no maximal exposure to plastic surgery, allowing for substantial variability in the training experience. Since most integrated programs have been and will be derived by conversion from current training pathways, the final three years of training have generally been established. We therefore hypothesized that the first three years of integrated residency training will show great variability in training between residency programs.
Methods: The rotation schedules for all 42 integrated programs were analyzed for plastic surgery and 18 non-plastic surgery rotations for PGY1, 2 and 3.Cumulative experience was also studied.. Additionally, rotations “strongly suggested” by the Plastic Surgery Residency Review Committee and American Board of Plastic Surgery were examined. Descriptive statistics were used to summarize the findings.
Results: PGY 1-3 residents spent a wide range of 3 to 19 months (SD ± 4.9) on plastic surgery (mean 9.1 months). General surgery experience also varied dramatically among programs with 8 to 21 months (SD ± 4.0) of exposure (mean 16.3 months). Surgical subspecialty rotations ranged substantially from 1 to 6 months (SD ± 1.0). Plastic surgery exposure was greater in programs based within plastic surgery departments than divisions (13.8 vs. 8.3 months, p<0.005). Residents spent more months on plastic surgery rotations with increasing seniority: PGY-1: mean 1.8, range 1-4 (SD ± 1.0); PGY-2: mean 2.2, range 0-6 (SD ± 1.6); PGY-3: mean 4.5, range 1-12 (SD ± 3.6). 18 programs (42.9%) had dedicated hand surgery rotations, while 7 programs (16.7%) had time dedicated for research. There was also wide variability in the number of programs that include 18 non-plastic surgery rotations as well as “strongly suggested”
rotations: oculoplastic surgery/ophthalmology 50.0%, oral and maxillofacial surgery 50.0%, acute burn management 78.6%, dermatology 81.0%, orthopedic surgery 85.7%, and anesthesia 92.9%.
Conclusions: The plastic surgery experience in the first three years of residency training varies remarkably by a greater than 6-fold difference between integrated programs. This was echoed in the 2.5-fold and 6-fold differences in general surgery and subspecialty surgery experiences, respectively. Since standardized residency training is an expectation by both accrediting bodies and the public, this variability may warrant closer observation.
Level of Evidence: II
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